When we first learned of it, this pandemic seemed to begin really badly. The numbers coming out of Mexico were simply... shocking. Over the next few weeks, we saw the WHO take us to full out pandemic levels at breath taking speed. The anxiety many, (most?), of us felt wasn't helped by not knowing exactly what was happening.
Where was it going? How quickly? Did it share the characteristics of known flu strains affecting humans or was there something new about it to worry about? So what have we learned?
Not unexpectedly, it's affecting younger cohorts far more than the normal seasonal flu strains... and the very young. Surprisingly, the over 65s, in fact... the over 52s or thereabouts; are doing prety well. Sadly it's taking a disproportionate toll on pregnant women. In Canada it's estimated 1% of the population is pregnant at any one time. 5% of confirmed flu cases have been pregnant women & of the 14 who've ended up in ICU - 4 have died. In absolute numbers ONLY 4 pregnant women have died and ONLY 89 or so Canadians have died. In very rough terms, 1 in every 389,000 has died from pH1N1, roughly 6 months after we began seeing cases here. That is not a high number, even considering many of these deaths did not occur during what we normally consider to be flu season.
And that taught us something else - that this strain was seemingly not prepared to 'respect' normal seasonality. Although absolute case numbers DID drop once schools let out for the summer & the weather warmed up, they never went away. There were small scale outbreaks all summer, most clustered around groups of children at camps & the odd day care.
Over the summer & early fall period, we learned other things. The normal triad of symptoms we see with flu - fever, moderate to severe coughing, as well as aches & pains with sudden onset - were not seen in all cases. Symptoms took an odd turn. People went to ER, consulted their doctors & some, who weren't showing definitive flu symptoms were tested anyway. And to the surpise of many... the patients, doctors, flu experts... they tested positive.
We've seen you don't have to have a fever, the aches & pains or at times, even a bad cough. Many would have sworn, (myself included), they just had an annoying cold. Except that the cold didn't go away & one morning you woke up with really bad symptoms or a secondary, such as pneumonia. Yet some people, the majority, still present with classic flu symptoms.
For MOST, this strain has been a fairly mild, (as far as flu goes!), self limiting illness. A couple of days home, then back to work. The only remarkable things about many of these mild cases has been lingering fatigue. That's gone on for over a month for many. Most tell us they never saw a need to even call their doctors. Rest, fluids & OTC meds as needed were all that was required.
But then we get the other extreme - people of various ages being hit very, very hard. From waking up feeling a bit punky to being in hospital that evening, ICU that night & in very desperate straits by the following morning. Utterly terrifying for their loved ones & frighteningly similar to 1918 for those of us following the course of this.
You know one thing we DON'T know? We hear some real horror stories about the Spanish Flu epidemic but we don't have a clear picture of how many were that desperately ill back then. For various reasons, reporting & record keeping weren't as they are today. Perhaps the early stages of their fall wave didn't differ much from this one, save for being offset a few weeks in time. Maybe it WAS a lot rougher & we simply don't have accurate counts. Time will soon tell us that.
It's been a frightening & confusing period for many, not helped by the fact that various levels of health authorities have vaccilated between being adamant about 'certain things' & throwing their hands up in despair at not having sufficient information. Frankly, I'm more comfy when they admit: "We don't know & we probably WON'T know until X-___ happens." Wouldn't that be a lot more honest?
Instead we've been given dire warning after dire warning about what COULD happen. Sure the worst COULD happen... or not much more than is happening now. But many health authorities are still sounding the alarm as though they KNOW thousands will start dropping dead tomorrow. Other interests are telling us this is all overblown hype. Which is it?
Damned if I know.
Here's what I know and see so far. I know a fair few by now who've had this flu. For most it HAS been relatively mild. Those who ended up with pneumonia, (mainly bacterial so far), have needed one, sometimes two courses of antibiotics & they get better. They stay awfully tired a while but the DO get better. Is the lower death rate we've seen so far due to a more open attitude, better surveillance & antibiotics? I think at least partly. I think it's also due in part to not as many serious primary cases... at least so far.
In my neck of the woods, we're in full blown second wave mode according to Public Health. From where I sit, it doesn't SEEM that bad. I'm seeing the same people I usually see for the most part. Sure, work last Tuesday was dead - only about 60% of the customers usually present were there. But I haven't noticed less traffic in the few stores I frequent & while I'm hearing of some sick - I'm not hearing of anyone I know being very, very ill. Not even very ill.
But to hear some of the health authorities... you'd think we're on the verge of catastrophic societal breakdown... but don't panic people! Just go line up, get your vaccine - in order of priority & don't panic. Remember, here's NO NEED to panic. Odd that - only ones I've heard using the 'panic' word are healthy authorities & government officials. I've no doubt 'panic' will make the 2009 Overused Word List.
Yo, gummint types:
Speaking of governments? Did anyone REALLY need any proof that if there are three ways to mess something up they'll come up with four... or five? Yup, really inspires confidence when they give the appearance of headless chickens racing around, blood flying. I'm not expecting perfection; a thoroughly reasoned, timely response at every step of the way. The 'government' consists of humans like you & me who have bad days, fight with their spouses, suffer gas attacks & get 'stupid tired' & sign off on the wrong policies once in a while. But honestly, it seems as though every last agency is determined to have a Very Bad Day all at once. This does nothing to inspire any degree of confidence in what's happening & the response.
Canada's response has been enough to make me thump my head to the point of a hangover type headache. They cancelled the seasonal flu vax campaign on the most flimsy grounds imaginable. They rushed approval of the formerly never licenced formulation based on very small scale tests from another country. They pushed forward vax clinic schedules & already problems are cropping up. They'll be solved but right now, with Canadians skeptical in the extreme, every misstep adds to the problems of public perception & action.
Many communities began the pH1N1 vax campaign earlier today. It's a bit early to know exactly how it's going but my supper time news is starting now & I hope they cover national news. If not, I'll catch it at seven on one of the national networks. I was listening throughout the afternoon, before our TV flutzed up & a very mixed picture was being presented. One clinic in the downtown Vancouver area was being slammed by those eager to get the vax - priority groups be damned. Edmonton was as well. Winnipeg interestingly enough was seeing very light attendance... surprisingly because they were the apex of the battlefield in the apring with their hospitals dangerously overloaded. Other cities, while not giving any estimated numbers were also reporting 'disappointingly' light attendance. In all fairness, some areas just decided on vax clinics & locations/times were announced over the weekend. That may not have left enough planning time for many.
We'll have to see how it plays out over the course of the week. Ontario, the biggest province by far, rolls out its vax campaign in full tomorrow. Some public clinics were available today but most were to vax health care workers. The lead quickie video on the lead in to our news showed our Chief Medical Officer roll up his sleeve.
But as a ton of different polls today showed & I posted some - people are saying: "Thanx, but no thanx!" Ah - just saw the needle go into his arm on the news & the comment he made was he feels it's important to put your money where your mouth is. Fair enough. 60% of people over aged 60 are looking to get the vaccine. 64% of those aged 18-35, (among the highest risk group), have no intention of getting it. They don't feel they're at risk. They don't think flu is a big deal. They don't place any trust in an untested, relatively untried vaccine.
People in Canada ARE taking common sense precautions. 65% of them wash hands way more often & use hand sanitizers. Churches have granted dispensation from services for people coughing or otherwise 'slightly' ill. Everyone coughs into their sleeve. Hand shaking is passe, as is air kissing. Canada's not a kissy kissy country anyway. Schools are waiving sick notes. Employers are more lenient about sick days.
One of the polling groups provided one of their staff for an interview to explain some of the data. He explains that part of the reason the vaccine is such a hard sell - over & above the lack of trust in an untested, adjuvanted vax, is that only FOURTEEN PERCENT of Canadians know someone who's had the flu. And most relate that the person or people they know who've had it recovered with no extraordinary help, no drama. If they percieve it as no biggie, then they decide on no shot.
That's informative... it tells me that most Canadians haven't had this yet - not even close. If you take that the next logical step, it suggests, things could be about to get interesting in a very nasty way. Or not. In a statement Friday, Canada's Chief medical Officer stated:
***It's possible that 5 per cent of Canada's population has already been infected with the virus and that another 20 to 30 per cent could get it over the next 18 months, Butler-Jones said.***
After the dire pandemic warnings we've been hearing & reading since April, most Canadians look at statements such as that one & think: "Big whoop! The 2002-03 year was worse." That was the year Fujian came calling - remember that? ERs jammed with sick kids... it was a heavy year for sure but is this one much worse - really? So far, not really for most - if you want to be brutally honest about it.
Our national CMO just ticked me off some more - getting 'righteously indignant' about anti-vaxers & accusing them of fear mongering. Maybe they are. But his follow on statement about, (paraphrased), "do you want it to be YOUR child on a vent or dead?"; is that not just as bad? We haven't lost many kids.
The hyperbole on one side is easily matched by hysterisa on the other & both are making matters worse. I don't know that this vaccine is 'bad'. I don't think it will turn out to be. I simply wish it had been tested last year with a different flu strain for safety with more than 130 people... in Europe. We could have done that. We didn't & THAT really ticks me off. Had that been done with decent results, far fewer today would be questioning the vaccine. I'll tell you, had I not had this flu last month, I STILL wouldn't be taking this vaccine. I don't do new vax or meds. I wait until long term data is available.
My SO was in for a pre op medical today & his GP asked his plans about vaccine. When he told her he wasn't taking it, she asked why not? He initially told her because I'd told him it wasn't a good idea. When she got him to elaborate, he told her my concerns about inadequate safety testing. To his surprise, she agreed. She doesn't think it's been a good idea to rush it out & is NOT recommending it, (not now anyway), to anyone who's not in a high risk group. She did say that should serious illness, complications & deaths start going up, she'd naturally change her recommendation, (as would I), but for now, she won't discourage people from taking it if they're not high risk but won't urge it on people either. She told him she'd had to have it earlier that morning - all the clinic staff did & she wasn't too happy about that. Nobody was. Wish SO had thought to ask her if anyone had refused.
I don't know what the next few months will bring. Here, it's estimated we've got a 'rough' 3-5 weeks coming, I suspect 5 is closer to the truth. That brings us to the end of November & by then, I figure most will have been exposed & had it or at least, built antibodies. Others will have had the vax - our public clinics start tomorrow. We have next to zero surge capacity at our hospital & a population that's heavy on seniors and pre-existing conditions.
Other parts of the country will be hit at different times with no doubt, differing degrees of severity. That's a crucial public health message NOT getting out - that you can't count on the community next to you having no cases or few to mean your town will have the same experience.
At this point, I can only be grateful that this didn't turn out to be H5N1 with it's truly horrific CFR. It's ironic that most people would have had an easier time making decisions about vaccine, pulling kids from school, staying home from work, etc. had this strain looked worse from the outset. But it hasn't been that bad & that's simply adding to the confusion. The reality experienced or witnessed by many is simply not matching up with the dire warnings.
The only clear thing is that right now, it's prety much impossible for most of us to avoid repeated exposures. We can wash our hands until they bleed, wear masks, avoid crowds as much as possible... we're still going to be exposed & we may get it. Luckily with this strain at least, that's adding up to a PITA more than a genuinely worrying experience. It's still frightening for those who either have pre-existing conditions themselves or have someone in the family with them - especially children.
As for those insisting everyone get a vaccine because it's their 'public duty', I hold them in as much contempt as I do those who swear vaccines are all poison, evil, part of a nefarious plot. Such determined attempts to 'force' people to see things their way are just wrong. Everyone is different. We all have different backgrounds, different concerns & different health issues, (or not), to consider. The best anyone can do is carefully examine FACTS. When facts are as yet unknown, consider probabilities, consider the history of vaccines in general. Some people definitely cannot take them & others are so strongly against vaccines, I should think accepting them would worry them so much, any positive effect of the vax would be negated by the effects of stress on the immune system. It's truly a decision everyone should make for themselves without considering pressure anyone might try to bring to bear. The same holds for staying home from work, keeping kids home - you have to do what feels right for you; what you're comfortable with.
We have several possibly difficult months to go through yet & possibly much of the difficulty will consist of the worry about not knowing what's going to happen, I HATE not knowing, especially when it's something crucial to the health of my family. But not knowing in this case, hardly appears likely to be the end of the world. This will continue to wax, level out & then wane in good time. And on the other side, most of us, if not all of us will still be right here, watching for the next threat.